Exposing a national crisis in Black mental health behind bars

When Dr. Samuel Cartwright coined the term “drapetomania” in 1864, he advanced a historical agenda to secure Black subjugation in America. Cartwright’s diagnosis of the desire for freedom amongst enslaved Africans as a form of psychosis exposes two important realities about mental health in the United States.

On Aug. 12, Mark-Anthony Johnson and Lynwood social worker Kristina Ronnquist pause at the entrance of the United Nations in Geneva, where they submitted the Dignity and Power Now report, “Impact of Disproportionate Incarceration and Abuse of Black People with Mental Health Conditions in World’s Largest Jail System“ for review of U.S. compliance with the International Convention to Eliminate all forms of Racial Discrimination (CERD).

First, the mental health of people of color in the United States, specifically Black people, is not a neutral arena. It is a critical battleground where racist ideologies have leveraged medical justifications for restricting Black people’s freedom.

Secondly, the mental health infrastructure in the United States, and lack thereof, is an expression of the historical agenda that Dr. Cartwright’s claim to fame represents. Promoting “drapetomania” as a clinical diagnosis only a year before the Emancipation Proclamation was signed posed strategic value to the Confederacy, which was being threatened by a civil war and needing to refine its justifications for chattel slavery in the United States.

The current crisis of criminalizing and incarcerating Black people with mental health conditions across the country is an extension of these two historical trends.

Over a period of two days, the United States was questioned and challenged by 18 U.N. committee experts who critiqued the nation’s deficiencies in addressing racial disparities. Our shadow report was an intervention not only in the local county conversation, but also on an international stage to expose a national crisis of criminalizing Black people’s mental health in the United States.

What does this crisis look like?

On any given day, Black people are six times more likely than White people to be incarcerated in the United States, and 63 percent of those Black people in local jails across the country have some form of a mental health condition (2006). Los Angeles makes key contributions to this trend, as Black people are 9 percent of the county population and 43.7 percent of its jail population diagnosed with “serious mental illness.”

The factors that account for this disproportionate impact are numerous. Black people, for example, are more likely to be misdiagnosed and at the same time less likely to receive the most effective treatments. Black people with mental health conditions are two to three times more likely than people of other races to be incarcerated as limited access to services increases the risk of incarceration.

The lack of community services, barriers to accessing them and lack of quality treatment upon access results in a systemic equation whereby “treatment” for Black people means incarceration.

Los Angeles is the largest jail system in the world. Additionally, the three largest mental health “treatment” facilities in the country – Los Angeles’ Twin Towers, Chicago’s Cook County Jail, and Rikers Island in New York – are all jail facilities.

In fact the Supreme Court ruled in 2013 that California needed to reduce its overcrowding that was exposing prisoners to greater risks of violence, medical neglect and abuse, lack of mental health care, and death. The realization that jails operate as de facto mental health facilities has gained more traction in recent years; however, the response has not been comprehensive or substantial enough to remedy the problem.

The situation of the mentally ill in jail is so dangerous and oppressive that the Department of Justice found unconstitutional conditions for the mental health population in LA County Jail system (May 2014) and a high level of physical abuse and the violations of rights for adolescents in New York’s Rikers Island Jail – particularly those with mental health conditions (August 2014). That tells us that the crisis persists.

Dr. Samuel Cartwright’s term “drapetomania,” coined in 1864, labeled the desire for freedom amongst enslaved Africans as a form of psychosis.

In fact, since the Civil Rights of Incarcerated Peoples Act was passed in 1997, the Department of Justice’s Civil Rights Division has found violations of the constitutional rights of people with mental health conditions in 35 correctional facilities across 25 states. Los Angeles is just one of the more recent exposures.

Despite these conditions, the Federal Bureau of Justice Statistics has no mechanism for the regular collecting of intersectional data based on the race and gender of incarcerated people with mental health conditions across the country. This creates serious barriers to monitoring the local and national trends.

Why is Los Angeles relevant?

As Los Angeles County develops plans for the diversion of people with mental health needs from the jails, it is also expanding jail capacity. It continues to stay the course despite the copious evidence and stories from our loved ones leaving the jails, that incarceration exacerbates mental health conditions.

In fact, in recent years there has been a movement for specialized detention facilities that are being couched as more responsive to the needs of prisoners. Californians United for a Responsible Budget (CURB) has been pushing back against the county and state push for “gender responsive” prisons and jails – the tagline for women’s facilities.

Though Los Angeles County claims to be planning to divert many mentally ill people from jail, its new jail plan is to tear down Men’s Central and erect a new “mental health jail” for the high number of mentally ill in the jail now.

The push for category specific incarceration further entrenches our loved ones into a system that cannot protect their rights, safety or humanity. In fact, Assistant Sheriff Terri McDonald recently reported to the Board of Supervisors that there has been a 47 percent increase in use of force at Century Regional Detention Facility, Los Angeles County’s dedicated women’s jail facility.

Dignity and Power Now used this mic to present their report to the U.N.

She attributed this increase to the rise in the mental health population at the facility. The pursuit of both mental health diversion and jail expansion undermines any comprehensive effort to address the crisis at its root.

A comprehensive diversion program would make use of services that have already proven to be effective, including Full Service Partnerships and Aggressive Community Treatment. Additionally, it is important that we are imaginative in how we envision the services our people deserve.

Job training and permanent job placement, permanent housing, and supportive services that include the intimate networks of those directly impacted are key to the long-term sustainability of mental health diversion.

The logic underlying the continuation and funding of the mass incarceration of the disproportionately Black mentally ill and Dr. Cartwright’s medical breakthroughs is the same: Black people’s mental health cannot be achieved, so society has to maintain extreme and inhumane restrictions on their freedom.

Mark-Anthony Johnson is a member of Dignity and Power Now (DPN) (www.endsheriffviolence.org). DPN, a multi-racial grassroots organization in Los Angeles and a member organization of Californians United for a Responsible Budget (CURB), fights for the dignity and power of incarcerated people and survivors of sheriff violence and their families with the goal of ending state violence and mass incarceration. Mark-Anthony and DPN can be reached at endsheriffviolence@gmail.com and can receive mail at the CURB LA office: P.O. Box 73688, LA CA 90003.

Suicide is the No. 1 cause of death in local jails and in the top five for prisons.

Incarceration further damages mental health

People with mental illness do not get better behind bars; they get worse! Being locked up means they are trapped without control or safety, often creating conditions for violence, hypervigilance and hopelessness.

Imprisonment exposes people to threat of violence, rape and trauma; disconnection from loved ones; loss of purpose and dignity; and extreme racism. All of these factors exacerbate, and sometimes entirely cause, mental illness.

Solitary confinement is used with greater frequency in the U.S. than in any other country in the world. Experts suggest that it fits the “cruel and unusual punishment” conditions required for an Eighth Amendment violation.

Locking people up cuts off their access to benefits; when they get out, they don’t have proper meds and may end up with costly emergency room visits, homeless, unemployed, and at high risk for recidivism and/or deterioration. They also have a criminal record, causing more barriers and then symptom exacerbation.

Jails and prisons are ill-equipped to treat mental illness

People with mental illness receive inadequate treatment or none at all behind bars, yet politicians use this to justify increasing spending for mental health services in prisons and jails. People should not have to get locked up to get treatment!

Only approximately 1 in 3 state prisoners, 1 in 4 federal prisoners, and 1 in 6 people in local jails who had a mental health problem received any treatment behind bars.

Individuals with mental illness are too often incarcerated while awaiting trial before even being convicted, rather than referred to hospitals or treatment centers.

Treating mental illness in prison is not cost effective either. One report in Michigan found that the annual cost of community case management for mentally ill people is $2,165 per person and a more intensive program costs the state $9,029 per person per year. In contrast, the average Michigan inmate costs the state over $34,000.

Jails are becoming de facto mental health providers

The nation’s penal system has become the largest provider of mental health services and their treatment protocols are neither effective nor humane. People need treatment, not punishment!

The deinstitutionalization of psychiatric hospitals in the 1950s, originally designed to expand community mental health, has instead resulted in thousands of people with mental illness being locked up through prison and jail expansion. Now people with mental illness are three times more likely to be incarcerated than hospitalized.

Los Angeles Sheriff is proposing to build a $1.74 to $2.32 billion Integrated Inmate Treatment Center, or a “mental health jail.” This facility would have 4,860-5,860 beds for people with mental illness. This project promotes false solutions that the penal system can and should be responsible for mental health services. Research shows that, even with “good” treatment, people with mental illness don’t get better while locked up.

We need to increase community programs, not incarceration

Community treatment, unlike imprisonment, helps people maintain social supports known to be an essential factor in recovery. These agencies work from a prevention model and address issues that lead to crime, such as homelessness and unemployment.

Fewer than half of incarcerated people with mental illness ever received treatment prior to their arrest, showing that we need to improve meeting community needs.

The new Affordable Care Act requires parity for mental health and substance use disorder treatment in all insurance plans. We have no excuse for restricting these services to people in need.

There are alternatives to incarceration

Thousands of successful community alternative programs exist. Two California examples:

San Francisco’s Behavioral Health Court, started in 2002, aims to divert individuals with mental illness from incarceration by connecting them to outside treatment and wraparound services.

The Integrated Recovery Network in Los Angeles, which aims to help homeless people with co-occurring disorders find housing, treatment and income, has shown that their services cost $12,000 one time per client versus $96,000 per year in public costs to re-incarcerate repeatedly.

People with mental illness deserve better

Mental Illness is not a choice and its symptoms can lead people to engage in behaviors they otherwise would not do. Violent crimes are not excusable, but our society needs a better system for treating mental illness than simply locking people up!

The Social Work Code of Ethics states that social workers “should advocate for changes in policy and legislation to improve social conditions in order to meet basic human needs and promote social justice.” The Marriage and Family Therapy code also mandates public advocacy.